The objective of this proposal is to design, implement, and evaluate a computer-assisted Patient Care Quality Assurance System (PACQUAS) which can be overlayed on an existing total-hospital Medical Information System (MIS). The existing total hospital system is operational and cost-effective in a community hospital such that the PACQUAS can be operated at a very low marginal cost utilizing the existing data base and the computer power supported by the existing fundamental MIS applications. The Patient Care Quality Assurance System will have four subsystems: (1) A computer-assisted diagnosis-particular, outcomes-oriented Nursing Care Planning Subsystem. (2) A computer-assisted Patient Care Audit Subsystem which integrates both concurrent and retrospective aspects of nursing audit, medical audit and utlization review into a coordinated patient care audit. (3) A computerized Patient-Care-Plan-Based Staffing Requirements Subsystem. (4) A computerized Services Coordination Subsystem for patient scheduling/services coordination from pre-admission through discharge. Care planning is key to the improvement of nursing quality and containment of its cost. Being cognizant of the data management problem which has limited the widespread usage of sophisticated care planning techniques we have sought to overcome the traditional barriers associated with making operational sophisticated patient care planning by building upon our successful total hospital information system experience. A good deal of our interest in this particular form of care planning revolves around its "outcome oriented" nature. Not only does this focus make good sense from a nursing management sense, it also provides a vehicle for integrating the mangement mechanisms of nursing labor resource allocation and quality control. It also provides a framework for determining near-term nurse staffing requirements. By adding a fourth subsystem (Services Coordination Subsystem) we obtain what is essentially a Hospital-wide Patient Care Quality Assurance System.